17 December 2009

I've not been blogging much lately because of work craziness and traveling. One of my recent travels, however, was not for work but for pleasure. I've been studying karate (a traditional Okinawan version called Shorin-Ryu) for over fifteen years. There's a national federation to which I belong and there are seminars three or four times a year taught by some of our more senior instructors. This was one such seminar, and it focused on joint lock and grappling techniques, some of which our style shares in common with other martial arts such as Akido and Judo.

At one point I was working with a fifth-degree black belt instructor, "Bill." Super nice guy, and absolutely amazing in his speed and techniques. He was also very kind in teaching me a number of useful tricks and nuances of the techniques we were working on. There was a sequence which culminated in a choke-hold, and he was unhappy with the manner in which I was choking him. We stood facing one another, and he demonstrated on me, reaching in with thumb and forefinger held claw-like and squeezing behind my trachea towards the base of my tongue.

It really hurt.

As he demonstrated, several other students gathered around to watch. While Bill held on to my throat, I reached out and mirrored the choke hold on his. "Is this right?" I asked.

"Not quite," says he, "You need to reach up more, like this." He squeezed a bit harder and I nearly went to my knees. I adjusted my grip and squeezed some more.

"Like this?""Yeah, that's about right," he gasped in a somewhat strangled voice, increasing the pressure on my throat once more.

So I responded by squeezing a bit more, and he did the same. I could feel his internal carotid pulsations quite distinctly underneath my fingertips. We stood there, pained smiles on our faces, and looked at one another for a bit. An unspoken question hung in the air: "How long are we going to let this go on?" It was only a matter of time (seconds, in all likelihood) before one of us lost consciousness. It seemed like it lasted forever, but after a few moments, by mutual agreement we pushed one another off to general laughter.

In karate seminars, it's always funny to watch people hurting each other. I don't know why.

That evening, back at the hotel, a large number of us went down to the hot tub to soak our bruises. The warm water soothed the pain, as did the beer we imbibed. I noticed Bill was not getting in the tub, but sitting by the side. I asked if he was not going to join us, and he demurred: "I can't use hot tubs," flashing a medic alert bracelet, "I have a heart condition and I am on coumadin."

It took a moment for this to sink in. Coumadin is a powerful blood thinner, and something of a mixed blessing. If you are prone to life-threatening clots, it can be life-saving. But it has so many complications, usually in the bleeding line: bleeding ulcers, severe bruising, and significant sensitivity to even minor trauma. My mind flashed back to earlier when my fingers had been wrapped around his windpipe.

"Holy crap!" I blurted out, "You're on coumadin and you let me squeeze your trachea? Are you out of your mind? What's your INR?"

"2.8," he responded, confirming that his blood was indeed adequately thinned. He laughed. "It's no big deal. I don't even bruise." It was true. He showed me his forearms, free of the bruises that were already flowering on my own. "My doctor says it's OK for me to do karate. He brags about me all the time."

"I'm going to brag about you, too," I responded. "But I still think getting into the hot tub probably wouldn't have been the most dangerous thing you've done today." He laughed and handed me another beer.

I checked his throat the next day -- not a mark to be seen. I tried not to be too mindful of his anticoagulation when we sparred, but it made no difference in any event -- he kicked my ass so thoroughly that I never had a chance to injure him!

It still makes me shake my head. Is there a worse possible hobby for someone on coumadin than martial arts? The mind reels.

Not a doctor here, but it sounds like a really good idea to me... Beat the crap out of your body until you don't bruise any more, get diagnosed with a heart condition... Get prescribed drugs... If he stops, his tolerance for bodily harm without bruising is going to decrease, isn't it? It seems as though if he keeps not bruising, and as long as he doesn't sword fight, he should be okay.

Actually, it's not as crazy as it sounds. I'm a second degree black belt in taekwondo karate and was the traditional weapons instructor for my school for many years.

The body tempers during martial arts training and can resist injury that the untempered body can't. I don't understand the science, but traditional martial arts all have techniques to do exactly this. In my federation black belts fight full-contact. I've seen people absorb blows that would crumple beginners. I don't bruise anywhere nearly as often as I did as a beginner, even though I take more impact now than before.

OK, first of all, the clause "he was unhappy with the manner in which I was choking him" is one for the books. I may spend the rest of my life looking for a way to bring this into a conversation. Kudos!!! Also, hobbywise, skydiving or anything involving a car, bicycle, or motorcycle, and high speed and/or rough terrain would seem to be poor choices for someone taking coumadin.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

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